Arena Pharmaceuticals, Inc.

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Application for Employment
AN EQUAL OPPORTUNITY EMPLOYER
All employment decisions are made without regard to unlawful considerations of race, sex, sexual orientation, gender identity, religion, national origin,
age, disability, or any other legally protected status. Reasonable accommodations are available to qualified disabled individuals, upon request.
PLEASE ANSWER ALL QUESTIONS Date:
PERSONAL INFORMATION
Name: (Last, First, Middle I.) Email Address:

Address: (Street Address/Apt #, City, State, Zip Code) Phone:

Are you over the age of 18? Yes No Without telling us which one, are you a US citizen, a Permanent Resident, or an
If no, you will be required to submit a work permit or proof of graduation from high Asylee Refugee? Yes No
school or the equivalent, if hired. (Proof of employment authorization status will be required if you are hired.)

Have you worked for us before? Yes No Do you have any relatives employed by us? Yes No
If yes, please state the date you left and the reason for leaving: If yes, please give names and relationship:

Have you ever worked for KPMG, Premiere Alliance, any of their affiliated entities, or any affiliated entities of such entities? Yes No
If yes, please describe:

EMPLOYMENT DESIRED
Position Applied For (Include Job Code) Date you can start, if offered employment Compensation desired

Are you applying for: Full-Time Part-Time Temporary Hours and days available:

Can you perform the essential functions of the job for which you are applying with or without reasonable accommodation? Yes No

If you are applying for an hourly (non-exempt) position, are you willing to work overtime? Yes No
Briefly describe your qualifications for this work and any special skills or experiences you possess that will be of special benefit in the job for which you are applying:

Which source prompted your application?

Advertisement Employment Agency Other - please indicate:

Walk In Employee Referral - Please provide name:

CRIMINAL RECORD HISTORY

Have you ever been convicted of a crime? (Do not respond concerning the following: arrests or detentions that did not result in conviction; referrals to, and
participation in, any pretrial or post-trial diversion program; marijuana-related convictions more than two years old; convictions for which the record has been judicially
ordered sealed, expunged, or statutorily eradicated; and misdemeanor convictions for which probation has been successfully completed or otherwise discharged and
the case has been judicially dismissed.) Yes No

If yes, what was (were) the offense(s)?

Date(s) and place(s) of conviction

A CONVICTION RECORD WILL NOT NECESSARILY BE A BAR TO EMPLOYMENT. Factors such as age at the time of the offense, type of offense and relevance to the job for which you are applying,
seriousness and nature of the offense, and rehabilitation will be taken into account.

EDUCATION
NAME AND ADDRESS COURSE OF STUDY YEARS LIST GRADUATED?
OF SCHOOL COMPLETED DEGREES YES/NO
High School N/A N/A N/A

Jr. College or College

University

Technical or Vocational School

 EDUCATION CONTINUED
Other Training or Degrees:
School(s) City/State
Course Degree or Certificate Earned

PROFESSIONAL LICENSE OR MEMBERSHIP:

Type of License(s) Held:

License Number & State:

License Expiration Date(s):

Other Professional Memberships:

(You need not disclose memberships that may reveal information regarding race, color, creed, sex, sexual orientation, gender identity, religion, national origin, ancestry,
age, disability, marital status, veteran status or any other protected status.)

REFERENCES
Please provide the name, address and telephone number of at least three people who would be willing to provide a business reference.
NAME/RELATIONSHIP ADDRESS/PHONE BUSINESS YEARS ACQUAINTED

1.

2.

3.

WORK HISTORY - Please fill out completely, even if accompanied by resume/cv. Attach additional pages if necessary.
List most recent work experience first (paid or unpaid). Account for all time and complete all items.
Company Name: Telephone: DATES EMPLOYED

Address: (Street Address, City, State, Zip Code) From: To:

Your Title and Description of Work Performed:

BASE RATE OF PAY
Start: End:

Supervisor: May we contact this employer for reference?

Reason for Leaving: Yes No

Company Name: Telephone: DATES EMPLOYED

Address: (Street Address, City, State, Zip Code) From: To:

Your Title and Description of Work Performed:

BASE RATE OF PAY
Start: End:

Supervisor: May we contact this employer for reference?

Reason for Leaving: Yes No

Company Name: Telephone: DATES EMPLOYED

Address: (Street Address, City, State, Zip Code) From: To:

Your Title and Description of Work Performed:

BASE RATE OF PAY
Start: End:

Supervisor: May we contact this employer for reference?

Reason for Leaving: Yes No

WORK HISTORY CONTINUED

Company Name: Telephone: DATES EMPLOYED

Address: (Street Address, City, State, Zip Code) From: To:

Your Title and Description of Work Performed:

BASE RATE OF PAY
Start: End:

Supervisor: May we contact this employer for reference?

Reason for Leaving: Yes No

Have you ever been discharged or asked to resign from a position? If yes, please explain:

CERTIFICATION

Read carefully before signing application.

I certify that the information given by me in this employment application and my resume (cv) is true and correct and contains no material or deliberate omissions of
any kind. I understand that any false statements or material omissions of fact made by me in this employment application or the interview process may disqualify me
from employment or result in my termination. I authorize Arena Pharmaceuticals, Inc. to investigate my background and fitness for employment, including, but not
limited to, an investigation of all the information provided in this employment application. I release Arena Pharmaceuticals, Inc its employees and agents from any
and all liability for failing to hire me or terminating my employment due to such false information or material omissions. I authorize the companies, schools or persons
named in this application to give to Arena Pharmaceuticals, Inc. any information regarding my employment or educational background, together with any information
they may have regarding my qualifications for the job for which I am applying, whether or not it is in their records. I hereby release said companies, schools or
persons and their employees and agents from any and all liability resulting from the disclosure of this information.

I UNDERSTAND AND AGREE THAT IF I AM HIRED, MY EMPLOYMENT RELATIONSHIP WITH ARENA PHARMACEUTICALS, INC. IS AT-WILL, WHICH
MEANS THAT IT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE OR ADVANCE NOTICE, BY EITHER ME OR ARENA
PHARMACEUTICALS, INC. In addition, if I am hired, Arena Pharmaceuticals, Inc. has the right to impose discipline or alter my position at its discretion. I
understand and agree that no representative of the Company may enter into any agreement contrary to the foregoing unless it is done by way of a specific, written
agreement signed by the President or CEO.

Signed: ____________________________________________________________ Date

This application will be kept active for 6 months.

Consideration for employment after 6 months will require a newly completed application.

FOR ADMINISTRATION ONLY:

Interviewed? Yes No By: (list all)

Applicant qualified for Position Applied for? Yes No Offer Extended? Yes No Accepted? Yes No

If No, date filed for future review: for (position) Date to destroy:

If Yes, Start Date: Title: Rate of Pay:

Department: Supervisor:
 ARENA AGREEMENT & CERTIFICATION REGARDING REGULATORY MATTERS
AND GOVERNMENT EXCLUSION MATTERS

Full name:

Have you ever used another name in a professional or official context? Yes No
If so, please list all other such names and the dates in which they were used?

1. Have you ever been debarred by the U.S. Food and Drug Administration (the USFDA) or
subject to a similar sanction in another jurisdiction (e.g., the European Medicines Agency,
sometimes referred to as the EMEA)?*

Yes No

2. Have you ever been disqualified or restricted as a clinical investigator by the USFDA or subject
to a similar sanction in another jurisdiction?*

Yes No

3. Do you have any knowledge of any circumstances which may affect the accuracy of questions 1
and 2 above, including but not limited to, USFDA investigations of, debarment or disqualification
proceedings against you?

Yes No

4. Have you ever been excluded from receiving federal contracts, subcontracts, or financial or non-
financial assistance or benefits from the United States government, or a similar exclusion in
another jurisdiction?*

Yes No

5. The United States government prohibits payment by any federal health care program (for
example, Medicare and Medicaid) for any items or services furnished, ordered, or prescribed by
an individual or entity excluded from participating in the program pursuant to the Social Security
Act. Have you ever been excluded from claiming payment from a federal health care program
in the United States or a similar exclusion in another jurisdiction?*

Yes No

6. Do you have any knowledge of any circumstances which may affect the accuracy of questions 4
and 5 above, including but not limited to, proceedings against you brought by the United States
Office of Inspector General or other governmental agency?

Yes No
 ARENA AGREEMENT & CERTIFICATION REGARDING REGULATORY MATTERS
AND GOVERNMENT EXCLUSION MATTERS (CONTINUED)

If you answered yes to any of the above questions regarding regulatory matters and/or government
exclusion matters, please indicate the circumstances.

I consent to Arena verifying any of the information contained in this document and agree to
immediately notify Arenas Regulatory Affairs Department and Legal Department if any of my
answers above change during my affiliation with Arena.

If you have any questions regarding this agreement and certification, or any of the references cited
herein, please contact the Legal Department (Executive Administrative Assistant, x 1315) at Arena
(+1-858-453-7200) prior to executing it.

Please sign and date below:

I certify that the information given by me in this agreement and certification is true and correct and
contains no material or deliberate omissions of any kind. I understand that any false statements or
material omissions of fact made by me in this agreement and certification may disqualify me from
employment or result in my termination.

Signature: Date:

* Links to additional information:

For information about debarment and disqualification (see questions 1 and 2 above), you
may refer to:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm176043.htm

For information about exclusion from receiving federal contracts, subcontracts, or financial
or non-financial assistance or benefits from the United States government (see question 4
above), you may refer to: https://www.epls.gov/epls/search.do

For information about exclusion from claiming payment from a federal health care program
(see question 5 above), you may refer to http://oig.hhs.gov/fraud/exclusions.asp

FOR BENEFITS/LEGAL ADMINISTRATION ONLY: The proposed new hire's name(s) have been
checked against (i) the FDA lists of debarred, disqualified, and restricted persons, (ii) the GSA
Excluded Persons List System, and (iii) the H&HS List of Excluded Individuals/Entities and was /
was not listed.

________________________________________________________________________
Signature Print Name Date